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80
Annual Report of the London County Council, 1911.
The circumstances of the remaining six cases were as follows :—
A had a case in June, was disinfected and resumed work and conducted some 30 deliveries,
all doing well. Six weeks after the first confinement a second case occurred, the patient was
found to be suffering from syphilis and to this cause the disease was attributed. The later
case proved fatal.
B had two cases in the same month, the second case was delivered before the first was
notified as puerperal fever. The first case was fatal.
C had two cases in three weeks. The first case was normal during the midwife's attendance
on it, but when notified the midwife was disinfected. The second case was confined four days
after her disinfection. Neither case was fatal.
D had two cases within three weeks. She was disinfected after the first case was notified
and resumed her work. Four days later the second case was confined and developed the disease
the day following. Both these cases were fatal.
E had two cases within six weeks. After the first case was notified the midwife was disinfected
and conducted several cases which went on well; the second patient had a ragged
placenta. Neither case was fatal.
F had two cases within 16 days. She was disinfected after the first case and seven days
later delivered the second case, which proved to be a very mild case. The former proved fatal.
Accidents of
Childbirth.
In addition to the list of deaths from puerperal septic diseases, the Registrar-General supplies
a weekly list of deaths from accidents of childbirth. Among these are included cases of eclampsia,
pulmonary embolism, puerperal mania and pneumonia occurring after confinement, as well as deaths
resulting from hæmorrhage and difficult labours. 152 deaths from accidents of childbirth were recorded
during 1911. In 15 of these cases the deceased was attended in her confinement by a midwife. The
cause of death in the 15 cases was as follows :—
Collapse following ante partum hæmorrhage 6
,, ,, post partum ,, 2
Rupture of the uterus 2
Eclampsia 1
Pulmonary embolism 1
Phlebitis 1
Suffocation due to regurgitation of food during labour 1
Convulsions 1
15
Ophthalmia
Neonatorum.
It is the duty of a midwife to advise that medical help is required when inflammation of the
eyes, however slight, occurs in infants. Great stress has been laid by the Council on the importance
of strictly observing this rule. When a notice is received from a midwife that medical assistance has been
sought on this account, the Council's medical inspector at once visits the infant to ascertain that it is
receiving the medical assistance which the midwife has advised, and the medical officer of health of
the borough in which the patient resides is immediately informed of the severity or otherwise of the
case and whether the infant is being removed to a hospital for treatment. The midwife is also visited to
learn particulars as to the case, the antiseptic precautions taken beforehand, and the disinfection adopted
by the midwife after each visit to the case. It was found in some cases that when medical assistance
was obtained, the medical practitioner, after examining the infant's eyes, gave directions to the parents
as to the course of treatment and left instructions for them to seek again medical help if the inflammation
did not yield to treatment, and if there was no improvement in the condition of the child's eyes.
So long as the midwife remained in attendance, the treatment was for the most part carried out, at all
events once a day; but many of these cases had not recovered by the tenth day, the time the midwife
usually ceases her attendance. It was also found impossible for the midwife personally to attend to
the infant's eyes as often as was requisite, i.e., in some cases four or five times daily, and this duty
was then left to the friends of the patient, who were utterly ignorant of the need for using clean rags
and sterile water.
The Council felt therefore that risk was being incurred by allowing cases of inflammation of
the eyes to receive no more attention than was bestowed on them by the people living in the house.
The Queen Victoria Jubilee Institute, the Ranyard Nurses Society, the Holloway Nursing Institute,
and the Nursing Sisters of St. John the Divine were therefore approached and asked if they would be
willing to allow their nurses to undertake, under the direction of the medical practitioner called in,
the care of these infants in order to see that the necessary irrigation or swabbing of the eyes was
properly done, and at the proper intervals. All the above societies readily consented and during the
year their services were made use of in 68 cases.
During the year 261 notices were received from midwives, stating that medical assistance had
been advised on account of inflammation of the eyes of infants, and, in addition to these, 17 other
cases came to light in which medical help was not called by the midwife ; the onset is stated to have
occurred after the midwife had ceased to attend in 13 of these 17 cases, in 3 the midwife failed to
advise medical help because the symptoms were slight and in one case a medical practitioner was
already attending the infant for other reasons. In 7 instances where medical help was advised it had
not been obtained when the Council's inspector visited the child. None of these cases was very severe
and the infants eventually recovered. There was delay in obtaining medical help in 14 cases due to